Buprenorphine maintenance program with contracted work/education and low tolerance for non-prescribed drug use: a cohort study of outcome for women and men after seven years

Abstract

BackgroundA seven-year follow-up of heroin dependent patients treated in a buprenorphine-maintenance program combining contracted work/education and low tolerance for non-prescribed drug use. Gender-specific differences in outcome were analysed.MethodsA consecutively admitted cohort of 135 men and 35 women, with eight years of heroin abuse/dependence on average was admitted to enhanced buprenorphine maintenance treatment. Standardized interviews, diagnostic assessments of psychiatric disorders and psychosocial conditions were conducted at admission and at follow-ups. Outcome associated with gender was reported for abstinence, retention, psychiatric symptoms, employment and criminal convictions.Results148 patients started treatment. After seven years, 94/148 patients (64%) were retained in the program, employed and abstinent from drugs and alcohol. Women had more continuous abstinence, retention and employment than men (76% versus 60%). After one year patients with a high-risk consumption of alcohol were no longer heavy consumers of alcohol and remained so throughout the study (p < .001). All women regained custody of their children.At admission, more women than men had been admitted for psychiatric disorders (70%/44%) and to compulsory care for substance abuse (30%/18%). Initial gender differences of psychiatric co-morbidity decreased and were no longer significant after one year.More men than women had been imprisoned (62% versus 27%) or in non-institutional care (80% versus 49%). Criminal convictions were reduced from 1751 convictions at admission to 742 (58%) after seven years.Eight patients in the entire cohort died over the 7 years (0.7% per year). One patient died in the completers group while still in the program (0.1% per year).ConclusionsAfter seven years, two thirds of the patients in the program were abstinent and employed. Convictions ceased in the completers group. One patient died in the completers group.Women had superior long-term outcome compared to men: more continuous abstinence, employment and fewer convictions. Women also lived with their children to a higher extent than men.The positive outcome highlights the importance of maintaining high structure in combining pharmacological treatment with a focus on employment and psychological treatment and low tolerance for non-prescribed drug use.

Long-term retention in Office Based Opioid Treatment with buprenorphine

“…As others have suggested, female patients may both gain more benefit from and more easily accommodate to the structure of a substance use clinic. (Öhlin, Fridell, & Nyhlén, 2015) This finding about female advantage for OBOT >1 year retention is consistent with work on short-term treatment retention. (Burns et al, 2015; Öhlin et al, 2015) While women may have better retention than men in OBOT, much remains much to be done to overcome the particular stigma and barriers for women to engage in care in the first place.…”

Long‐Term Retention in an Outpatient Behavioral Health Clinic With Buprenorphine

“…These findings suggest that women may do better in BHC‐based MOUD programs over time whereas men are more likely to leave treatment. This may speak to different factors related to women remaining in treatment as seen in prior studies including fewer convictions within the legal system and motivating factors of regaining custody or maintaining relationships with their children …”

Sex Differences in Regional Brain Glucose Metabolism Following Opioid Withdrawal and Replacement

“…Despite these data, our knowledge of the neural circuitry involved in opioid withdrawal remains incomplete. However, recent studies have shown that sex likely influences these pathways, and may actually affect treatment outcomes (Jimenez-Trevino et al, 2011;Ohlin et al, 2015).…”

“…A 25-year follow-up of heroin-dependent patients prescribed METH indicated that surviving women were significantly more likely than men to have stopped heroin use (Jimenez-Trevino et al, 2011). Similarly, a 7-year followup study of heroin-dependent patients treated with BUP showed that, again, women were significantly more likely than men to have stopped heroin use (Ohlin et al, 2015). Finally, Sheynin et al (2016) observed that only males receiving replacement therapy (METH or BUP) demonstrated abnormal avoidance behavior.…”